The fate of the last remaining clinic that provides abortions in Missouri is set to be decided after a hearing beginning in St. Louis this week. If the clinic is forced to stop performing abortions, Missouri would become the first state in the nation to be without at least one such clinic.

A state commission is reviewing a licensing dispute between Republican Gov. Mike Parson's administration and Planned Parenthood, which operates the clinic in St. Louis.

In July, the center came within days of stopping abortion servicesafter state officials refused to renew the license, citing violations of state health regulations. But after Planned Parenthood filed a lawsuit, it was allowed to stay open while the case is pending.

Parson, who opposes abortion rights, has said that the health and safety of patients is at the heart of the dispute. Planned Parenthood officials contend that regulators with the Missouri Department of Health and Senior Services have "weaponized" the regulatory process, applying arbitrary and excessive scrutiny to the clinic in an effort to shut it down.

"This serves as an example of how abortion access could effectively be banned without ever overturning Roe [v. Wade]," said Rachel Sussman, national director of state policy and advocacy at Planned Parenthood Federation of America.

The matter is before the state's Administrative Hearing Commission, where a single commissioner, acting in a capacity similar to a judge, will consider the case. The first part of this week is expected to focus on the state's case, with a response from Planned Parenthood coming later in the week, Planned Parenthood officials say.

Spokespersons with Missouri's Department of Health and Senior Services and the state attorney general's office declined to comment while the matter is pending.

Abortion rights opponents also are watching the case closely. Maureen Ferguson, a senior fellow with The Catholic Association, said states have a right to regulate clinics and if clinics fail to meet those standards, "then they ought to be shut down."

Ferguson noted that Planned Parenthood is opening a large new clinic to provide abortions across the state line in Illinois, a state with less restrictive abortion laws.

"One can hardly say the sky is falling on abortion access when there's a new mega-clinic about 15 minutes from the clinic that's being shut down," Ferguson said.

Sussman, with Planned Parenthood, sees the efforts by Missouri state regulators as part of a larger strategy by abortion rights opponents at all levels to restrict the procedure nationwide.

"The governor in the state – and frankly the Trump-Pence administration – has kind of invited states across the country to aggressively act on restricting access to abortion," Sussman said, "and this is another strategy, another attempt to do just that, by shutting down the last health center in the state providing care."

The U.S. Supreme Court said recently it would take up a Louisiana case that challenges health regulations aimed at abortion providers – a case advocates on both sides of the abortion debate also are watching closely. The court's new conservative majority, which includes two of President Trump's nominees, is widely expected to allow additional restrictions on abortion.

The American College of Obstetricians and Gynecologists has said that heavy regulation of clinics that provide abortions is unnecessary and creates barriers to abortion access.

Copyright 2021 NPR. To see more, visit https://www.npr.org.